Clinton's Health Plan

The City

One Of An Occasional Series

In Practice, Clinton Health Plan May Not Be Cure-all For The Poor

Clinton Plan May Not Be Cure-all For Poor

Lydia Chacom, a single mother with three school-age children, likes what she has heard so far about President Clinton's health care plan.

Like thousands of other poor mothers in Hartford, Chacom has health insurance through a federal program intended to help low-income families. But it often does not work very well.

Recently, her 9-year-old daughter, Veronica, got sick, and when Chacom called a health clinic for an appointment, she was told she should go to the hospital instead because her doctor wasn't available.

At the Hartford Hospital clinic, they waited more than three hours. Finally they saw a doctor who knew nothing about Veronica's complicated medical history.

"People could die waiting," Chacom said. "A private doctor takes care of you better. He already knows your health history. He knows much more about you."

In theory, the Clinton plan would have an enormous effect on a city such as Hartford, enabling tens of thousands of low-income families to get the same kind of service and care as people with private insurance. But in practice, many experts say, other economic and social forces may interfere.

An estimated 247,000 Connecticut residents have no health insurance, and more than 225,000 others are covered through publicly funded programs for the poor or disabled, according to state and federal figures. The other 2.8 million people in the state presumably have private insurance or Medicare, the federal insurance program for the elderly.

Most adults with no insurance are the so-called working poor -- people who have low-paying jobs that provide no health insurance.

In Hartford alone, about 61,000 people -- nearly half the

city's population -- had either no insurance or government insurance in 1989, according to one survey.

The architects of the Clinton proposal say that nonprofit health clinics -- where most of the poor now get their care -- would continue to exist, but would enter the mainstream, allowing them to expand their buildings and staff and offer care as timely and complete as private doctors' offices.

"It is the end of the ghettoized health care system," said Kevin Anderson, a Clinton spokesman. Poor people "would have the same health card in their wallet that the banker across town has in his wallet, and they can go to the same doctors and the doctors will be compensated exactly the same."

Health care experts throughout Connecticut and the nation like much of what they see in Clinton's plan, but many question if it would really eliminate the disparities.

For example, just giving everyone a national health care card entitling them to medical treatment would not necessarily mean there would be enough doctors in urban areas to care for the thousands of poor people.

Others wonder what would prevent the health care plans under Clinton's proposal from trying to sign up mostly doctors who work in the suburbs, where it might be easier to make a profit.

Some also question whether low-income people -- even with the subsidies proposed -- would be able to afford the premiums, or the $10 charge many would have to pay for each doctor's visit.

And some experts say there might not be enough emphasis on educational programs that would teach low-income people to focus on preventive care such as vaccinations instead of waiting for an emergency to go to the doctor's office.

Lydia Chacom, who is unemployed, and her family fall under the federal and state-funded Medicaid system. Because few private doctors will accept the low payments offered under the program, the Chacoms must go to city hospitals or clinics.

Hartford's poor have seven places they may go for care: three stand-alone health clinics, a city health department clinic and three out-patient clinics sponsored by the city's three hospitals. All of the city's clinics do what they can to personalize care, but they are much busier than an average doctor's office.

In addition to having long waits, patients often are not seen by the same doctor each time. For adults, there is not as much emphasis on preventive care -- screenings for breast cancer or other adult conditions -- as in the private sector.

Chacom and thousands of other poor Hartford residents also have a tendency to go to emergency rooms for routine care, figuring they can get quicker service at any hour.

Late last month, Chacom took her family to the emergency room at St. Francis Hospital and Medical Center when a second daughter, 14-year-old Lissette, was feeling ill. That cost the hospital more than if Lissette had visited the family's regular clinic during the day.

"She was in school during the day," Chacom explained.

This merry-go-round of doctors often leads to repeated short-term solutions to what really are chronic conditions such as inner-ear infections or asthma, common among poor city children.

Low-income people with no insurance not only have the same problems as the Chacoms, but also risk high expenses.